Coralee Ruth Koning, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA14217 Issued in CA

Practice address

2335 E Kashian LN Ste 260
Fresno, CA 93701-2234

Phone

(559) 256-5130

Fax

(559) 485-4504

NPI assigned

Oct 7, 2005

Last updated

Sep 14, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Mrs. Coralee Ruth Loberg Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northbay Healthcare Group

  dba dba NorthBay Medical Center

  • General Acute Care Hospital
  • Fairfield, CA
  • NPI 1821147786
  Medicare reassignment NPD
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment
• Emergency Physicians Urgent Care Inc.

  dba Accelerated Urgent Care

  • Urgent Care Clinic/Center
  • Bakersfield, CA
  • NPI 1689963845
  Medicare reassignment
• Sun Medical Group, Inc

  dba AFC Ladera RAnch

  • Urgent Care Clinic/Center
  • Ladera Ranch, CA
  • NPI 1114588704
  Medicare reassignment
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Madera, CA
  • NPI 1750337184
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Murrieta, CA
  • NPI 1588552848
  NPD
• Emergency Physicians Urgent Care Inc.

  dba Accelerated Urgent Care

  • Urgent Care Clinic/Center
  • Bakersfield, CA
  • NPI 1629442728
  NPD
• Northbay Healthcare Group

  dba NorthBay VacaValley Hospital

  • Multi-Specialty Clinic/Center
  • Vacaville, CA
  • NPI 1760534713
  NPD
• Sun Medical Group, Inc.

  dba AFC Urgent Care Anaheim

  • Urgent Care Clinic/Center
  • Anaheim, CA
  • NPI 1114673902
  NPD
• Rapid City Indian Health Service Hospital

  • General Acute Care Hospital
  • Rapid City, SD
  • NPI 1316900327
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1992793525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 E DIVISADERO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211431",
            "telephone_number": "559-443-2682",
            "fax_number": "559-443-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2335 E KASHIAN LN STE 260",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937012234",
            "telephone_number": "559-256-5130",
            "fax_number": "559-485-4504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONING",
        "first_name": "CORALEE",
        "middle_name": "RUTH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-07",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60188369",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA153205",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA14217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500655889",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - PHS - WA",
            "identifier": "P01238392",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORALEE",
            "last_name": "LOBERG",
            "middle_name": "RUTH",
            "prefix": "MRS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Aravinda Reddy Kolan, M.D.
• Donald Christopher Kolz, RYT, FTP
• Katherine Jean Kong Gonzalez
• Jean Kong, RPH
• Maliny K Kong
• Michael Youngblood Konkle
• Maciej J Kopacz, M.D.
• Sharon Monica Kopacz, MD
• Nicole Marie Kopari, MD
• Dawnette Kopfman

• Medical Physician Assistant in Fresno, CA
• Providers in Fresno, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.